Critical illnesses include ailments like heart disease, cancer, organ failure, major organ transplant, kidney disease, coma, stroke, etc. These illnesses affect your day-to-day life for an extended period of time and are also quite expensive to treat. Purchasing a critical illness policy will ensure that if you are ever diagnosed with a critical illness, one that meets the insurer’s criteria, you will receive a lump sum payout from the insurer. There are no restrictions on how one can utilize this amount. You can use the funds to take care of the immediate financial needs of your family, cover hospitalisation expenses and recovery costs, plan for a lifestyle change, or can also serve as an income replacement.
To demonstrate how critical illness health insurance plans work, let’s take the example of Rajesh, who purchases a critical illness cover for himself for a sum insured of Rs.5 lakh. He pays the due premiums and renews the policy every year. During one such policy term, Rajesh suffers from a critical illness which causes him to be hospitalized for a few days. Rajesh’s total hospitalisation bills have come up to Rs.4 lakh. Rajesh receives a lump sum payout from the insurer after the 30-day survival period. He utilizes this amount to pay for his post-hospitalisation expenses and as an income replacement for the months that he does not work. The critical illness policy enabled Rajesh to get back on his feet smoothly, and not worry about his liabilities.
Critical illness policies offer both the policyholder and their families several benefits, such as:
|Insurer Name||Plan Name||Age Range||Basis||Coverage Offered||No. of Critical Illnesses Covered||Co-Payment||Waiting Period|
|SBI General Insurance||Critical Illness Insurance Policy||18 years – 65 years||Individual Plan||Up to Rs.50 lakh||13 critical illnesses||90-day waiting period for all claims|
|HDFC ERGO||Critical Illness Insurance Policy||5 years – 65 years||Individual Plan||Up to Rs.10 lakh||8 critical illnesses||90-day waiting period for all claims|
|HDFC ERGO||Critical Illness Platinum Insurance Policy||5 – 65 years||Individual Plan||Up to a maximum of Rs.10 lakh||15 critical illnesses||90-day waiting period for all claims|
|IFFCO-Tokio General Insurance||Critical Illness Insurance Policy||Group Plan||9 critical illnesses and accidental injuries||90-day waiting period for all claims|
|Reliance General Insurance||Reliance Critical Illness Plan||18 years and above||Individual Plan||Up to a maximum of Rs.10 lakh||10 critical illnesses||90-day waiting period for all claims|
|Tata AIG General Insurance||Critical Illness Policy||18 years – 65 years||Individual (Retail) Plan||Up to a maximum of Rs.15 lakh||11 critical illnesses||3-month waiting period for claims|
|Bajaj Allianz Insurance||Critical Illness Plan||6 years – 65 years||Individual Plan||For ages 6 – 60 years: up to Rs.50 lakh For ages 61 – 65 years: up to Rs.5 lakh||10 critical illnesses||3-month waiting period for claims|
|Bajaj Allianz Insurance||Critical Illness for Women||21 – 65 years||Individual Plan||Up to Rs.2 lakh||8 critical illnesses||90 days waiting period for critical illness claims|
|Universal Sompo General Insurance||Critical Illness Insurance Plan||Proposer: 18 – 65 years Others: 5 – 65 years||Individual Plan||Up to a maximum of Rs.20 lakh||11 critical illnesses||90 days waiting period for claims related to critical illnesses 48 months waiting period for claims made due to pre-existing diseases|
|Bharti AXA Health Insurance||Smart Critical Illness Insurance Plan||8 years – 70 years||Individual/Family Floater Plan||Up to Rs.5 lakh||20 critical illnesses||60-day waiting for critical illness claims 4-year waiting period for pre-existing diseases|
|New India Assurance||Asha Kiran Policy||Adults: 18 – 65 years Daughters: 3 – 25 years||Family Floater Plan||Up to Rs.8 lakh||11 critical illnesses||Co-pay may be applicable if the insured undergoes treatment in a different zone, from which he/she lives in||General claims: 30 days Pre-existing diseases: 48 months Congenital diseases/defects: 48 months|
|Star Health Insurance||CriticCare Plus Insurance Policy||18 – 65 years||Individual Plan||From 18 – 65 years: Up to Rs.10 lakh From 60 – 65 years: Up to Rs.2 lakh||9 critical illnesses||General claims: 30 days Pre-existing diseases: 4 years Specific conditions (As mentioned in the policy brochure): 1 or 2 years|
The Critical Illness Insurance Policy provides a cover for up to 13 major critical illnesses. For this plan, the minimum age of entry is 18 years and the maximum age of entry is 65 years. Policy buyers can choose a policy tenure of either 1 year or 3 years. The minimum and maximum sum insured are Rs.2 lakh and Rs.50 lakh, respectively. However, for individuals over the age of 60 years, the maximum sum insured is capped at Rs.15 lakh. The premium that one will have to pay towards this policy will vary based on the age of the insured, the sum insured opted for, policy term, and gender.
The Critical Illness Insurance Policy from HDFC ERGO comes with two policy tenure options - 1 year and 2 years. As per this policy, the insured will receive a lump sum amount 30 days after the disease is first diagnosed, and this is amount can be used by the policyholder to pay for hospitalisation expenses, to pay off any outstanding debts, or as income replacement. The minimum and maximum sum insured for this policy is Rs.2.5 lakh and Rs.10 lakh, respectively. Individuals before the age of 45 years, who wish to purchase this policy do not have to undergo any medical tests or examinations.
The key benefit of the Critical Illness Platinum Insurance Policy from HDFC ERGO is that it offers a cover for 15 critical illnesses, to anybody between the ages of 5 years and 65 years. Medical tests are only required if the prospective policy buyer is over the age of 45 years. As per the policy terms, the insured will receive a lump sum payout from the insurer, if any one of the 15 critical illnesses have been diagnosed, provided they complete the 30-day survival period. You can choose a sum insured of Rs.2.5 lakh, Rs.5 lakh, Rs.7.5 lakh, or Rs.10 lakh. The insurer offers lifetime policy renewability to the insurer.
This policy covers up to 9 critical illnesses, including Coronary Artery Diseases (CAD), cancer, organ transplant, etc. It also covers any expenses arising out of severe injuries caused due to an accident. This policy is ideal for groups, such as members of an organization, groups identified by the Central or State Governments, employees and students from educational institutions, members of affinity groups, etc. Members of this policy can avail cashless hospitalisation or claim for a reimbursement of medical expenses, provided the ailment/illness does not fall under the insurer’s exclusion criteria.
The Critical Illness Plan from Reliance General Insurance offers policyholders a comprehensive cover for 10 critical illnesses. The plan can be purchased by anyone over the age of 18 years, and the policy buyer is only required to undergo a medical test if he/she is over the age of 45 years. The buyer can choose a sum insured of Rs.5 lakh, Rs.7 lakh, or Rs.10 lakh and a policy tenure of 1 year or 3 years. Further, a prospective policy buyer can purchase this plan digitally, by making use of payment options, such as net banking, mobile wallets like Paytm, UPI, or debit/credit cards, which are provided by the insurer.
The Critical Illness Policy from Tata AIG provides a one-time, lump sum payout in case the policyholder is diagnosed with any one of the 11 critical illnesses that meet the insurer’s criteria. Besides this, the policyholder is also entitled to receive a Second Opinion Benefit. If the insured is diagnosed with a critical illness, and wants to take a second opinion, the insurer will be liable to pay all costs related to this. The minimum sum insured for this plan is Rs.2.5 lakh and the maximum sum insured is Rs.15 lakh. The prospective policy buyer needs to be over the age of 18 years and under the age of 65 years to purchase the policy. The policy can be renewed for life, if the renewal happens every year without any breaks.
This plan offers a critical illness cover for individuals between the ages of 6 to 65 years. If the insured is diagnosed with a critical illness, he/she will receive a lump sum critical illness benefit from the insurer. The minimum and maximum sum insured for those between 6 and 60 years of age is Rs.1 lakh and Rs.50 lakh, respectively. If you are between 61 and 65 years of age, you can opt for a maximum sum insured of Rs.5 lakh. This is a yearly policy with lifetime renewability.
This is a critical illness plan that is specially catered towards women between the ages of 21 years and 65 years. This policy offers the insured several benefits, such as a critical illness cover for 8 illnesses, cover for congenital disabilities, and a Children Education Bonus and a Loss of Job Bonus, if the insured is diagnosed with the critical illness. This is an affordable plan, and the minimum and maximum sum insured are Rs.50,000 and Rs.2 lakh, respectively. The policy buyer may have to undergo a medical test on the basis of the sum insured amount selected and the age at which the policy is purchased.
The Critical Illness Insurance Plan offered by Universal Sompo can be purchased by any individual over the age of 18 years. The critical illness cover can be extended to the proposer’s spouse, children, parents, or parents-in-law. Any individual over the age of 5 years can be enrolled under this plan. This policy can be purchased for a period of 1 year, 2 years, or 3 years. The policy buyer can opt for any sum insured between Rs.2.5 lakh and Rs.20 lakh. The policy covers 11 major critical illnesses and surgeries.
This policy comes in two variants – an individual plan and a family floater plan. Under the individual plan, you have the whole sum insured amount to yourself, while under the family floater plan, the sum insured amount is available to the whole family. The policy covers 20 critical illnesses, and policyholders can avail cashless treatment in over 4,300 hospitals across India. You can choose a sum insured of Rs.2 lakh, Rs.3 lakh, or Rs.5 lakh. Policyholders will receive a no-claim bonus for every claim-free year and a discount for every year that the policy is renewed.
The Asha Kiran Policy is a family floater type policy, which will provide a critical illness cover to the proposer, the spouse, and up to two dependent daughters. The policy covery 11 critical illnesses, and a prospective policy buyer can choose a sum insured of Rs.2 lakh, Rs.3 lakh, Rs.5 lakh, or Rs.8 lakh. Premiums will be linked to the age of the eldest family member. This is an annual policy, with lifetime renewability. The policy also covers pre-existing diseases and congenital defects, after the completion of the waiting period.
The CriticCare Plus Insurance Policy offers policyholders, between the ages of 18 and 65, a cover for up to 9 critical illnesses. If the insured is diagnosed with a critical illness that falls under the insurer’s criteria, he/she will receive a lump sum payout from the insurer. There is no survival period under this policy. The sum insured can also be utilized for the regular hospitalisation. Pre-existing illnesses, specific illnesses, and non-allopathic treatments are also covered, after completion of the due waiting period, if any. The policyholder can avail cashless hospitalisation in over 8,200 hospitals across the country.
Listed below is the general exclusion criteria for most critical illness health insurance policies. For an exclusion criteria that is specific to your policy, ensure you go through the policy document/brochure.
Given our current lifestyle, a critical illness could strike anybody, at any age. Considering how medical costs have only been increasing each year, it is wise to invest in a critical illness policy. Critical illness health insurance policies will provide you a cover, in the form of a lump sum payout, for the major critical illnesses and surgeries that meet the insurer’s criteria.
The actual number of critical illness that will be covered vary from policy to policy. However, most insurance plans cover illnesses, such as heart attack, cancer, dialysis due to renal failure, organ transplant, strokes, heart surgeries, coma etc. Some insurers may also provide a cover for severe bodily injuries caused due to accidents. You will have to consult your insurance advisor or read the policy brochure to know the exact number and names of critical illnesses which will be covered.
Most critical illness policies will provide the insured a lump sum payout 30 days after he/she is diagnosed with the critical illness. This 30-day period is called the survival period, and might vary from insurer to insurer.
Most insurers set the maximum age of entry to 60 or 65 years. After this age, new policies cannot be bought. However, many insurers offer lifetime renewability to the policyholder, as long as he/she continues to renew the policy every year.
No, most critical illness policies do not cover pre-existing diseases. However, there are a few insurance policies that will provide you a cover for pre-existing diseases, specific diseases, and congenital defects, provided you renew the policy every year till the completion of the waiting period (4 years, in most cases.)
While some critical illness insurance plans are available on a solely individual basis, some policies can be purchased as a family floater. However, even if a plan is not available as a family floater, you can still choose to buy individual critical illness plans for family members.
Most insurers will allow you to increase or decrease your sum insured amount only at the time or renewing your policy. While making any enhancements to the sum insured amount, you must ensure that they fall under the insurer’s limits.
All policies come with a waiting period. While the general waiting period for critical illness health insurance plans range between 30 and 90 days, there could also be a waiting period of 2-4 years for pre-existing diseases. Any claims that you make during the waiting period will be rejected, except for claims related to accidental injuries. You can only start making claims after the completion of the waiting period. You won’t have to go through the waiting period if you are renewing the policy.
Your claim could be rejected if:
A health insurance policy will cover only the billable aspects of your hospitalisation, whereas the critical illness will offer you a lump sum payout after the disease is diagnosed and the survival period is completed. This enables the policyholder to use the payout however he/she desires. Critical illness policies cover only the illnesses/surgeries that are specifically mentioned in the policy document.
Yes, most critical illness insurance policies cover day-care procedures and treatments that do not require the insured to be hospitalized for 24 hours, as long as it meets the insurer critical illness criteria.
The factors affecting your premiums are:
If you don’t make any claims during the policy term, most insurers will pay you a no-claim bonus or a discount for the following year. However, this is applicable only if you renew your policy the following year.
When you undergo cashless hospitalisation, you will not have to pay your hospitalisation bills while being discharged from the hospital. All relevant medical expenses will be borne by the insurer. However, you can avail cashless hospitalisation facility only at a network hospital.
Yes, you can cancel your policy if you don’t find the policy terms and conditions to be satisfactory. The insurer will provide you with a free-look period (15 days or 30 days, usually), during which you can cancel your policy and have the insurer reimburse whatever you paid.